Six in ten people living with dementia will wander at least once, and many do it repeatedly. That figure is from the Alzheimer's Association, and it is the reason this is a plan you make in advance rather than a thing you deal with when it happens.

The families we work with who handle it well are not the ones with the best locks. They are the ones who had a photo ready, knew who to call, and knew what the first fifteen minutes are for.

What counts as wandering?

Not only leaving the house. It is any attempt to get somewhere that the person can no longer navigate to, including inside a building. Somebody who walks out of a hospital waiting room looking for the parking lot is wandering.

It is also worth saying that it is usually purposeful from the inside. They are going to work, collecting a child, going home. The destination is real to them even when it stopped existing decades ago, which is why blocking the door without addressing the reason rarely holds.

What are the warning signs that someone is at risk?

The Alzheimer's Association lists these:

• Returning from a regular walk or drive later than usual.
• Forgetting how to get to familiar places.
• Trying or wanting to go home even when they are at home.
• Becoming restless, pacing, or making repetitive movements.

That third one is the one families dismiss, because it sounds like confusion rather than a risk. It is the clearest single predictor on the list. If somebody is asking to go home while sitting in their own living room, the plan below is worth having ready this week.

What do I do in the first fifteen minutes?

Have this decided before you need it, because you will not be thinking clearly.

1. Start searching immediately. Do not wait to see if they come back.
2. Search the immediate area first. The Alzheimer's Association notes that many people who wander are found within 1.5 miles of where they disappeared. Look close before you look wide, and check the direction of anywhere they used to go regularly.
3. At fifteen minutes, call 911. The Alzheimer's Association is specific about this: if the person is not found within fifteen minutes, call 911 and file a missing person report. There is no waiting period and nobody will think you overreacted.
4. Tell the dispatcher the words memory impairment or dementia. This is what changes the response, in Massachusetts specifically. See below.

Keep a current photograph and a written note of height, build, what they usually wear, and the addresses of places they used to live or work. Put it somewhere any family member can find in thirty seconds. This is the single most useful ten minutes of preparation on this page.

What is a Silver Alert, and does Massachusetts have one?

Yes. Massachusetts has a statewide Silver Alert system written into state law at Chapter 6A Section 18L. It is developed and run by the executive office of public safety together with the State Police.

The statute says the system is used, when appropriate, to alert public safety departments when an adult with serious memory impairment such as Alzheimer's disease or other dementia is reported to a police department as a missing person. It also directs the search geographically, using the last known location and the available research on how people with dementia actually move.

The practical point for a family: the trigger is a missing person report to the police. So the fifteen minute rule above is not just about starting a search, it is what opens the door to this.

Should I register them with the police before anything happens?

If your town offers it, yes, and it costs nothing.

A number of Massachusetts police departments keep their own local registration on top of the state system. Duxbury, as one example, has families complete a form at the police department or the senior center giving details and photo identification, held confidentially and used only if that person is later reported missing.

Programs vary town by town, so call your own department's non emergency line and ask whether they keep a Silver Alert or cognitive impairment registration. The answer takes one phone call and it means the photograph and description are already in their hands rather than being found on somebody's phone at ten at night.

How do I reduce the risk without locking someone in?

The instinct is to secure the exits. That is part of it, but on its own it produces somebody trying the door all day, and it is not what the guidance leads with.

• Give the day a shape. The Alzheimer's Association puts structured, meaningful activity throughout the day first. Wandering fills a vacuum. An afternoon with nothing in it is the risk.
• Find the time of day it happens. It is usually consistent. Once you know the hour, you can put something in it. If it is late afternoon, read our piece on sundowning and what actually helps, because the two overlap heavily.
• Cover the basics first. Toileting, food, drink. The Alzheimer's Association names these explicitly. A lot of what looks like wandering is somebody looking for a bathroom.
• Remove the car keys if driving is no longer safe. Not hidden, removed. Hidden keys get found.
• Avoid busy, confusing places. Shopping malls, large parking lots, crowded waiting rooms. Disorientation in those settings is where a lot of separations start.
• Take the walk on purpose. Somebody who gets out every day with company is far less likely to go out alone at four in the morning.

What about hospital and clinic appointments?

This is the situation we see most, because it puts every risk factor in one place: an unfamiliar building, a long wait, a full waiting room, and a family member who has to step away to the desk for two minutes.

If you are bringing someone with dementia to an appointment, plan for somebody to stay physically with them for the whole visit rather than nearby. This is one of the things our staff do on a medical transport, and it is the reason we advise against a drop off for a patient with memory impairment. More on how that works in do I need a responsible adult after my procedure.

Where to start in Massachusetts

Three calls, in this order.

1. Your local police department's non emergency line, to ask about registration.
2. MassOptions on 1-800-243-4636 , who route you to your regional Aging Services Access Point for a free in home assessment and tell you what you qualify for.
3. The person's doctor, if the wandering is new. A sudden change in behavior is worth ruling out an infection or a medication effect before treating it as the disease progressing.

If the honest answer is that somebody cannot safely be left alone any more, that is a staffing problem rather than a locks problem. We cover what care at home actually costs in can I afford Alzheimer's care at home in Massachusetts, and what to ask an agency before you hire.

Care Remedy Inc, 100 TradeCenter Suite G-700, Woburn, MA 01801. Call 781-957-8076. Our home health aides provide supervision and companionship for people living with dementia across Greater Boston, the South Shore and the Pioneer Valley, including escorted transport to appointments.

Sources: Alzheimer's Association, Wandering · Massachusetts General Laws Chapter 6A Section 18L, Silver Alert. This article is general caregiving guidance and not medical or legal advice. Local police registration programs vary, so confirm with your own department.